Ventilator-Associated Pneumonia in Patients With Increased Intra-abdominal Pressure

Abstract

Increased intra-abdominal pressure (IAP) is a significant clinical concern, which has been proven to cause significant adverse events in patients. Respiratory infections are a high-yield problem in the intensive care unit (ICU). In this study, we reviewed available literature regarding the relationship between elevated IAP and the development of ventilator-associated pneumonia (VAP) in mechanically ventilated patients. Patients with prolonged mechanical ventilation are prone to develop VAP. Longer hospitalization, prior use of antibiotics, and comorbidities make these patients more susceptible to infections. Multidrug-resistant VAP poses a vast threat to critically ill patients, as it is characterized by a shift in the microbiological profile of the disease, as well as difficulties in its treatment options. Elevated IAP could adversely affect mechanically ventilated patients, as it is associated with an elevated risk of microaspirations and altered patency of the intestinal barrier, thus comprising an important factor for developing VAP. In addition, elevated IAP can deteriorate pulmonary function and hemodynamic condition of the patient, adding an extra risk for developing VAP. In such frail conditions, these patients have compromised immune function and are at risk of developing systematic infection, even resulting in the failure of multiple organs. As the microbiologic profile shifts toward multidrug-resistant bacteria, there is a need for comprehensive strategies in ICU settings to mitigate the risks associated with both elevated IAP and multidrug-resistant VAP. Timely intervention and proper management can prevent the risk of difficult-to-treat infections and life-threatening adverse events for patients.

Keywords: intra-abdominal hypertension; intra-abdominal pressure; mechanical ventilation; multidrug resistant (mdr); ventilator-associated pneumonia.

Figure 1. Pathophysiology and association between elevated IAP and VAP.

IAP: intra-abdominal pressure; VAP: ventilator-associated pneumonia; AKI: acute kidney injury Figure credits: Christos Doudakmanis